Lamotrigine-induced DRESS with purpuric lesions in the oral mucosa

Bozca, Burçin Cansu; Ünal, Betül; Alpsoy, Erkan

doi:10.1016/j.jdcr.2019.09.012

Cited by 4 publications

(7 citation statements)

References 10 publications

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“…Five of our studies presented patients with DIHS, 6 of our studies presented patients with, 6 of our studies presented patients with DRESS syndrome, 1 study presented patients with PLS, and 1 study presented a patient with lamotrigine overdose. [10][11][12][13][14][15][16][17][18][19][20][21][22] The most common presenting diagnosis was DIHS or DRESS. The presentation of DIHS and DRESS is most commonly seen within 5-6 weeks of initiation of the offending agent, with a range from 1 to 24 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Resolution of skin lesions and biologic abnormalities resolved in 3 weeks. 18 Bozca et al 19 reported a case of a 31-year-old female with epileptic seizures presented to the hospital with widespread rash, fever, and fatigue following initiation of lamotrigine 3 weeks before. Lamotrigine was initiated at a dose of 12.5 mg for the first 2 weeks, and then, a dose escalation in week 3 to 25 mg/day.…”

Section: Lamotriginementioning

confidence: 99%

“…Following initiation of treatment, the patient's signs and symptoms improved rapidly in 2 weeks and she was discharged. 19 Mylonakis et al 20 reported a case of a 49-year-old male with bipolar affective disorder who presented to the hospital with a 2-day history of low-grade fever, erythema, and edema involving the periorbital area. Five days prior to hospital admission, lamotrigine was initiated.…”

Section: Lamotriginementioning

confidence: 99%

See 2 more Smart Citations

Evaluation of Anticonvulsant-Induced Leukocytosis: A Review of Evidence for Carbamazepine, Lamotrigine, and Phenobarbital

Sutton,

Csurgo,

Reinert

2024

Journal of Pharmacy Technology

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Objective: The objective was to determine the incidence of leukocytosis associated with carbamazepine, lamotrigine, and phenobarbital. Data sources: A comprehensive literature review was conducted with the assistance of a medical reference librarian on PubMed, MEDLINE, Embase, and Google Scholar through June 2023 using the following search terminology: “leukocytosis/chemically induced”[MeSH Terms] AND (“Anticonvulsants”[MeSH Terms] OR (“Anticonvulsants”[Pharmacological Action] OR “Anticonvulsants”[MeSH Terms] OR “Anticonvulsants”[All Fields] OR “anticonvulsant”[All Fields] OR “anticonvulsion”[All Fields] OR “anticonvulsive”[All Fields] OR “anticonvulsives”[All Fields]) OR (“Anticonvulsants”[Pharmacological Action] OR “Anticonvulsants”[MeSH Terms] OR “Anticonvulsants”[All Fields] OR “antiepileptic”[All Fields] OR “antiepileptics”[All Fields])). Study selection and data extraction: Thirteen reports were included from 64 potential results of our literature review following the application of inclusion and exclusion criteria: 7 of the reports involved carbamazepine, 4 of the reports involved lamotrigine, and 2 of the reports involved phenobarbital. Data synthesis: Drug-induced leukocytosis is commonly a diagnosis of exclusion and is a phenomenon that has numerous ramifications to patients and clinicians at the bedside, including mandating a full infectious evaluation, the identification of confounding variables, and the eventual discontinuation of the offending agent. Despite several medications and medication classes possessing this adverse drug effect, an evaluation of the specific clinical presentation and management strategies for drug-induced leukocytosis associated with anticonvulsant medications has not been elucidated in the literature. Conclusions: Clinicians should be judicious when evaluating leukocytosis in patients on potentially precipitating medications, including carbamazepine, lamotrigine, and phenobarbital.

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Section: Discussionmentioning

confidence: 99%

Section: Lamotriginementioning

confidence: 99%

Section: Lamotriginementioning

confidence: 99%

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Evaluation of Anticonvulsant-Induced Leukocytosis: A Review of Evidence for Carbamazepine, Lamotrigine, and Phenobarbital

Sutton,

Csurgo,

Reinert

2024

Journal of Pharmacy Technology

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“…1,2,5,6 In most studies it is emphasized that this syndrome usually appears after the administration of a drug, with aromatic anticonvulsants being most frequently observed, followed by sulfonamides (drug involved in this case), glycopeptide-type antibiotics and allopurinol, among many others. 1,2,[7][8][9][10][11][12][13] The clinical picture usually begins two to six weeks after the start of consumption of the associated drug. They typically debut with fever (predominant sign), morbiliform rash (up to three-quarters of cases), mucosal involvement, generalized lymphadenopathy, and constitutional symptoms such as asthenia, adinamia, and arthralgia.…”

Section: Discussionmentioning

confidence: 99%

DRESS syndrome by sulfonamides, about a case

Contreras¹,

Zepeda

Gutiérrez³

et al. 2022

Int J Basic Clin Pharmacol

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Among the most feared toxico-dermas is drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, a rare drug dermatitis that occurs after acute exposure to drugs whose clinical impact is based on multiple organs (skin, liver, kidneys, lungs, heart) and cell lines (eosinophils and lymphocytes). It is an entity with high mortality if it is not identified early, its treatment consists of the immediate suspension of the responsible drug and the administration of steroids, these being the therapeutic protagonists. A 64-year-old male patient with clinical, biochemical and histopathological criteria compatible with DRESS syndrome. It is essential to suspect the clinical course of DRESS syndrome before the appearance of dermatosis with multisystem involvement associated with the use of drugs, emphasis is placed on its early identification and the establishment of timely treatment to modify its prognosis.

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“…4 Although, the second case, lesions were widespread with palate involvement (Table S1). 5 Severe cutaneous adverse effects caused by Lamotrigine were associated with rapid dose titration, concurrent valproic acid administration, and the history of an anticonvulsant-associated allergic skin reaction. 6 In our case, the concomitant intake and increase of Valproic acid dose may have worsened skin lesions.…”

mentioning

confidence: 99%

Atypical presentation of lamotrigine‐induced drug reaction with eosinophilia and systemic symptoms

Salah

Soua

Trimeche

et al. 2021

Dermatologic Therapy

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Paradoxical worsening of clinical symptoms after the withdrawal of the causative drug was reported in several cases of DRESS syndrome. 3 Clinical features appear commonly 2 to 4 weeks after administration of the offending drug. Clinical presentation consists of cutaneous manifestations and visceral involvement. Several case reports of Lamotrigine-induced DRESS syndrome manifested fever, rash, lymphadenopathies, eosinophilia, and hepatitis. The latter is the most reported manifestation. The typical skin lesions consist of a morbilliform eruption, involving over 50% of the body, usually associated with facial edema and infiltrative lesions. Our case is unusual by its clinical presentation. To the best of our knowledge, this is the first case with purpuric edema of extremities with palmoplantar involvement. Previously, two cases of Lamotrigine-induced DRESS syndrome were associated with purpura. The first case developed purpuric lesions on ankles, knees, and buttocks. 4 Although, the second case, lesions were widespread with palate involvement (Table S1). 5 Severe cutaneous adverse effects caused by Lamotrigine were associated with rapid dose titration, concurrent valproic acid administration, and the history of an anticonvulsant-associated allergic skin reaction. 6 In our case, the concomitant intake and increase of Valproic acid dose may have worsened skin lesions. Valproic acid is an enzyme inhibitor that prolongs the half-life of Lamotrigine, elevates its serum levels, and potentializes cutaneous side effects. 7 Systemic steroids are indicated in case of visceral involvement including transamininase levels >5 times normal, renal involvement, pneumonia, cardiac involvement, or hemophagocytosis. 8 Systemic steroids were given to our patient because of the severity of skin lesions.

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Lamotrigine-induced DRESS with purpuric lesions in the oral mucosa

Cited by 4 publications

References 10 publications

Evaluation of Anticonvulsant-Induced Leukocytosis: A Review of Evidence for Carbamazepine, Lamotrigine, and Phenobarbital

Evaluation of Anticonvulsant-Induced Leukocytosis: A Review of Evidence for Carbamazepine, Lamotrigine, and Phenobarbital

DRESS syndrome by sulfonamides, about a case

Atypical presentation of lamotrigine‐induced drug reaction with eosinophilia and systemic symptoms

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